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Vermont Speech-Language-Hearing Association
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juliaslp
Posts:1
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| 06/28/2008 9:02 AM |
 Alert
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Vermont Health Care Partnership has a long standing history of excluding funding of AAC devices. The following letter was written to attempt to address this issue.
Paula DiStabile
State of Vermont
Department of Banking, Insurance, Securities & Health Care Administration
89 Main Street
Montpelier, VT
05620-3101
802-828-3301
Re: coverage of augmentative communication devices by BCBS and other carriers
June 19, 2008
Dear Ms. DiStabile,
I am writing to you concerning the general exclusion clause contained in the Vermont Blue Cross Blue Shield policy that prohibits funding augmentative communication devices.
Augmentative Communication Devices are generally “high tech” computer based devices that provide an alternative to spoken language. You may be familiar with Steven Hawkins, the well known physicist. Dr. Hawkings has Amyolateral Lateral Sclerosis or ALS, a degenerative condition that affects the ability to move, swallow, speak, and eventually, breathe. Dr. Hawkins communicates using a complex, computer based system that allows him to participate in his own health care and personal and professional life.
The ability to communicate is considered to be a human right by the First Amendment of the Bill of Rights to the United States Constitution, Article 19 of the Universal Declaration of Human Rights, the National Joint Commission for the Communication Needs of Persons with Severe Disabilities, Section RI.2.100 of the Joint Commission of Hospital Accreditation, and many other national and international organizations.
Augmentative communication devices are covered services by Medicare, Medicaid in 50 states, Tricare, and numerous private insurance companies.
Vermont Blue Cross Blue Shield excludes all augmentative communication devices. The following is a quote from their policy:
“In the Vermont Health Partnership Certificate of coverage of communication devices, communication augmentative devices and computer technology or accessories or other equipment, supplies or treatment intended primarily to enhance occupational, recreational or vocational activities, hobbies, or academic performance are listed as a benefit exclusion, general exclusion number 21.”
Augmentative communication devices address a medical need and meet the definitions for medical necessity from a variety of sources including Vermont Medicaid which defines medical necessity as “usually, an AT device or service is considered medically necessary if it will help a child to function more independently, improve or maintain current levels of functioning or prevent further deterioration in his or her condition.”
Augmentative Communication Devices meet the criteria for classification as durable medical equipment. That is, AAC devices meet the following standards:
•Able to withstand repeated use
•Is primarily and customarily used to serve a medical purpose
•Is generally not useful to the person in the absence of illness or injury
•Is suitable for use in the home
My understanding is that your department has some say over the policies of organizations that practice in the state of Vermont. Please consider reviewing the policy of Vermont Blue Cross Blue Shield and other insurance companies who deny people with communication disorders the basic human right to communicate.
Thank you for your time and attention. Please do not hesitate to contact me with any questions.
Thank you,
Julia Lynch, M.A., CCC-SLP
75 Stonecrest Avenue
White River Junction, VT 05001
juliaslp@gmail.com
cc:
Vermont Blue Cross Blue Shield
Susan Mason, PT, Vermont Medicaid
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